Post-traumatic renal arteriovenous malformation failed endovascular embolization.

Renal arteriovenous malformations (AVMs) are abnormal connections between the renal arteries and venous system. Arteriovenous fistulas account for 70%-80% of renal arteriovenous abnormalities, often resulting from iatrogenic injuries. While most renal AVMs are asymptomatic, hematuria is a common symptom caused by AVM rupture into the renal calyces. Angiography is the gold standard for diagnosis, but noninvasive imaging techniques like ultrasound, computed tomography, or magnetic resonance imaging are commonly used for initial evaluation. Most renal AVMs are managed conservatively. Symptomatic patients typically undergo endovascular embolization, the preferred treatment, while surgery is reserved for unstable patients or those with complex vascular anatomy. We present a case of a 32-year-old man with renal AVMs following a motor vehicle accident. The patient initially received unsuccessful endovascular embolization but achieved successful treatment through open fistula ligation. This case highlights the challenges in managing renal AVMs and the importance of considering alternative interventions when initial treatments prove ineffective.

Distal sciatic neuropraxia secondary to lithotomy position: A case report and literature review.

Urolithiasis is one of the commonest urological diseases that can greatly impact the health status of patients with a high socioeconomic burden. Retrograde intrarenal surgery (RIRS) has been considered to be the surgery of choice for small renal stones (Less than 2 cm) due to its feasibility and safety. However, even with potentially low risk, complications can still result with RIRS. In this article we present a unique case of a 12-year-old male who had complete foot drop as a complication following RIRS. No similar case has been reported in the literature.

Nail Gun Penetrating Renal Injury: A Case Report.

The kidney is the genitourinary organ most affected by trauma, although the retroperitoneal location provides some protection. Renal injuries are classified according to the mechanism of trauma. Most of the penetrating renal injury cases in the literature are due to knife stabbing or handguns. We present an interesting case of a 22-year-old male with a penetrating renal injury caused by an electric nail gun. There was no report of a similar case in the literature.

Intraoperative diagnosis of seminoma in a man with cryptorchidism and Klinefelter Syndrome planning for m-TESE: A case report.

Undescended testes are more likely to undergo malignant transformation than normally descended testes. We present the case of a 33-year-old male smoker who had been suffering from primary infertility for 4 years. This patient had bilateral undescended testes and a frozen section specimen revealed seminoma. In this report, we discussed how important it is to use a combination of different diagnosis modalities to reach a diagnosis.

Ureteral intussusception: a case report and review of literature.

Ureterorenoscopy (URS) is a minimal invasive procedure used for diagnosis and management of the upper urinary tract. Due to the vast advancement in URS technologies, the efficacy and safety greatly improved with lower complication rates. Intussusception is a rare complication of URS. We report a case of iatrogenic ureteral intussusception that was managed with ileal interposition.

Effect of hormonal manipulation using clomiphene citrate prior to microdissection testicular sperm retrieval.

INTRODUCTION: Microdissection Testicular Sperm Extraction (micro-TESE) is a surgical method used for retrieving sperm from men with non-obstructive azoospermia. Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM) that stimulates luteinizing hormone (LH) and follicle-stimulating hormone (FSH) production. It is believed that treating patients with CC prior to micro-TESE increases the chance of sperm retrieval. METHODS: This retrospective study was conducted in a tertiary care center in Riyadh, Saudi Arabia and included all patients who underwent Micro-TESE from August 2015 to November 2018. Data related to the pre-surgery hormonal levels, testicular volume, and associated genetic abnormalities were collected. chi-square and t-test were used to compare variables. A p-value of less than 0.05 was considered significant. RESULTS: A total of 122 patients were included in this study, with 30.0% (n=37) treated with CC. The overall sperm retrieval rate was 44.3%. Micro-TESE results were not statistically affected by age, testosterone levels, Klinefelter syndrome, or taking CC. However, higher testicular volumes and lower LH and FSH levels had more positive micro-TESE results. CONCLUSION: In conclusion, Micro-TESE results were not affected by CC, age or testicular volume.

Sloughing Prostatic Tissue, a Rare Complication Post Rezum Therapy: A Case Report.

Benign prostatic hyperplasia (BPH) is the most prevalent urological disease in men that leads to lower urinary tract symptoms (LUTS). The clinical presentation is, most likely, obstructive symptoms such as intermittency, hesitancy and poor stream, due to the obstructive nature of the pathology. BPH treatment approach varies. However, they can be divided into two main approaches which are non-surgical and surgical. Non-surgical methods usually started first, such as lifestyle modifications, watchful waiting, and medications. Hence, surgical intervention remains the mainstay of treatment to relieve clinical symptoms. Although transurethral resection of the prostate (TURP) is the gold standard, management is shifting towards minimally invasive surgeries such as Rezum due to its good outcome and fewer adverse effects. We present a case of prostatic tissue sloughing, a rare complication post Rezum system therapy in a 50-year-old male.

The perception and competency of undergraduates in urology: Is the clinical exposure necessary?

OBJECTIVE: The objective of this study is to investigate medical students' perception, choices of future career, and competency in urology. METHODS: A cross-sectional survey was distributed among 5th, 6th, and 7th(interns) year medical students at King Saud bin Abdulaziz University for Health Sciences using both hard copies and soft copies. Major outcomes were medical students' perception, future career decision, and core skills in urology. RESULTS: The overall response rate was 51.3%. A total number of 163 responses (122 were males and 41 females) were collected. Only 8% indicated that they would pursue a surgical career in urology and 42% thought that they had received a good clinical exposure to urology. Of the participants, 67.5% viewed urology as a male-dominated field. Only 17% of the respondents either agreed or strongly agreed that they were considering a future career in urology. Female students were less likely to consider a urological career (P < 0.01). About 32.5% were confident at urethral catheterization. About 66.9% felt that a workshop day to enhance urological skills and knowledge will be beneficial. Females were more confident at assessing a urological case in an acute setting (P < 0.05). CONCLUSION: Most of the students agreed that their urology exposure was inadequate and their confidence at urethral catheterization was low. As in many different global studies, urology is still regarded as a specialty with a male dominance. This report is consistent with the global decline in formal urological education.

Association between the mode of transport and in-hospital medical complications in trauma patients: findings from a level-I trauma center in Saudi Arabia.

BACKGROUND: In Saudi Arabia, injury is the leading cause of death. Even if nonfatal, the impact of injuries on population health is enormous, as thousands of young patients suffer permanent disabilities every year. Unlike in developed countries, private transportation (PT) is a common means to transport trauma patients. Outcome differences between patients transported via PT relative to emergency medical services (EMS) has not been previously explored. OBJECTIVES: To evaluate the association between transportation mode and in-hospital complications among trauma patients. DESIGN: Retrospective. SETTING: Tertiary care center. PATIENTS AND METHODS: The study included all patients (>=16 years), who were admitted following trauma. MAIN OUTCOME MEASURES: The main outcome in the study was the occurrence of any medical complications including stroke, sepsis, myocardial infarction, pulmonary embolism, pneumonia, renal failure, acute respiratory distress syndrome, and cardiac arrest. RESULTS: The 493 patients were relatively young (over two-thirds of the sample were 45 years old or younger) and over half the population sustained injuries due traffic crashes. More than half (58%) of patients arrived via private transportation. Regression analyses revealed that in-hospital complications following injuries were significantly lower among those who arrived via PT. However, after incorporating propensity score matching, we found no difference in hospital complications (OR=0.55, 95% CI 0.25-1.17). CONCLUSION: Multiple factors may influence this unexpected finding, such as distance to health care set.tings, the belief that PT is faster or lack of knowledge of the EMS contact number. Further efforts are needed to raise awareness of the importance of using EMS to transport trauma patients to hospitals. Prevention programs to reduce traffic crashes may facilitate reduction in traumatic injuries and associated complications. LIMITATIONS: Retrospective and conducted in one center only.

Kidney cancer in Saudi Arabia. A 25-year analysis of epidemiology and risk factors in a tertiary center.

OBJECTIVES: To evaluate available epidemiological data and risk factors for kidney cancer in a tertiary care center in Riyadh, Saudi Arabia, over a period of 25 years. METHODS: This retrospective study conducted in a tertiary care center included all adult patients with primary kidney cancer who presented and were managed between 1990 and 2015. Based on this information, we forecast the incidence of the disease in our center over the next 5 years (2016 to 2020). RESULTS: In total, 371 patients were included in the study. The mean age of the patients was 56.3 years and the majority were male (61%). Among the patients, 55.8% were diagnosed incidentally. At the time of diagnosis, 53.2% were hypertensive, 46.2% were diabetic, 39.1% had dyslipidemia, and 25% were smokers. In addition, most patients were obese (42.3%) or overweight (30%). The most frequent histopathological variants were clear cell and chromophobe. Most patients presented with Stage 1. Minimally invasive surgery (laparoscopic, robotic) was performed in 55% of cases. Based on these data, we predicted that 172 new cases will present at our tertiary care center in 5 years from 2016 to 2020. CONCLUSION: The incidence in kidney cancer is increasing and is associated with an alarming increase in the prevalence of associated risk factors.

Burnout and its association with extracurricular activities among medical students in Saudi Arabia.

OBJECTIVES: To assess levels of burnout in medical students, and to explore the influence of extracurricular activities on burnout at a medical school in Saudi Arabia. METHODS: This cross-sectional study was conducted with first to fourth year medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia. Socio-demographic, burnout level (the Maslach Burnout Inventory-Student Survey, MBI-SS) and participation in extracurricular activities data were collected using a self-administered questionnaire. Statistical analyses were performed using the Pearson's chi-square test and binary logistic regression. RESULTS: From the 306 medical students approached, 249 (81.4%) completed the questionnaire. The level of high burnout was 67.1% (n=167). The study revealed that the majority (62.3%, n=155) of students had high levels of cynicism, 58.6% (n=146) had high levels of emotional exhaustion, and 60.2% (n=150) had low levels of professional efficacy. Most of the students (73.5%, n=183) participated in extracurricular activities, and 112 (45%) students were organizers of extracurricular activities. No significant association was found between burnout levels and the frequency of involvement in extracurricular activities (χ2=2.2, df=2, p=0.333). However, students who were organizing extracurricular activities were less likely to have low professional efficacy (OR=0.51, 95% CI: 0.27- 0.96). CONCLUSIONS: High levels of burnout were reported at this medical school. Although the burnout level is not significantly associated with the frequency of involvement in extracurricular activities, leading and organizing extracurricular activities might result in lower levels of burnout. Therefore, improving the students' leadership skills should be considered in curriculum planning, and greater emphasis should be placed on the quality of involvement in extracurricular activities rather than the quantity.

The prevalence and association of stress with sleep quality among medical students.

INTRODUCTION: Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. METHODS: This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. RESULTS: A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p<0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, p<0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). CONCLUSION: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment.